Artikel
Non-aneurysmal subarachnoid hemorrhage: factors influencing shunt dependency – a single-center series and multivariate analysis
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Autoren
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Patrick Schuss
- Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Alexis Hadjiathanasiou
- Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Simon Brandecker
- Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Ági Güresir
- Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Hartmut Vatter
- Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
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Erdem Güresir
- Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Patients presenting with spontaneous, non-aneurysmal subarachnoid hemorrhage (nSAH) are known to have a good prognosis. Nevertheless, some patients might develop shunt-dependent hydrocephalus throughout the treatment course. We therefore analyzed our neurovascular database to identify factors determining shunt-dependency after nSAH.
Methods: From 2008 to 2016, 131 patients suffering from spontaneous nSAH were admitted to our department. NSAH was defined as angiogram-negative, spontaneous SAH. Information, including patient characteristics, previous intake of anticoagulation or antiplatelet medication, presence of acute hydrocephalus, radiological features, shunt-dependency during treatment course and functional neurological outcome were assessed and further analyzed. Patients were stratified according to the distribution of cisternal blood into patients with perimesencephalic SAH (PMSAH) versus nonperimesencephalic SAH (NPSAH). Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months and stratified into favourable (mRS 0-2) versus unfavourable (mRS 3-6). A multivariate analysis was performed to identify predictors of shunt-dependency in patients suffering from nSAH.
Results: Overall 18 of 131 patients suffering from spontaneous nSAH developed a shunt-dependent hydrocephalus (14%). In detail, patients with NPSAH developed significantly more often shunt dependency during treatment course, when compared to patients with PMSAH (p=0.02). Furthermore, patients with initial insertion of external ventricular drainage (EVD) due to acute hydrocephalus developed significantly more often shunt-dependent hydrocephalus, when compared to patients without initial EVD (p<0.0001). In the multivariate analysis, “previous EVD insertion” was the only significant and independent predictor for shunt dependency in patients with nSAH (p<0.0001).
Conclusion: Overall, the rate of shunt-dependent hydrocephalus in patients with nSAH was 14% in the present series. Univariate analysis revealed NPSAH-blood distribution and the necessity of initial EVD insertion as significant risk factors for shunt dependency in patients with angiogram-negative SAH. However, multivariate analysis identified initial EVD insertion due to acute hydrocephalus as significant and independent predictor for shunt dependency in patients suffering from nSAH.
